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Dr. Brytney Cobia said Monday that all but one of her COVID patients in Alabama did not receive the vaccine. The vaccinated patient, she said, just needed a little oxygen and is expected to fully recover. Some of the others are dying.

“I’m admitting young healthy people to the hospital with very serious COVID infections,” wrote Cobia, a hospitalist at Grandview Medical Center in Birmingham, in an emotional Facebook post Sunday. “One of the last things they do before they’re intubated is beg me for the vaccine. I hold their hand and tell them that I’m sorry, but it’s too late.”

Three COVID-19 vaccines have been widely available in Alabama for months now, yet the state is last in the nation in vaccination rate, with only 33.7 percent of the population fully vaccinated. COVID-19 case numbers and hospitalizations are surging yet again due to the more contagious Delta variant of the virus and Alabama’s low vaccination rate.

Read More: New COVID surge begins in Alabama, hospitalizations double in July

For the first year and a half of the pandemic, Cobia and hundreds of other Alabama physicians caring for critically ill COVID-19 patients worked themselves to the bone trying to save as many as possible.

“Back in 2020 and early 2021, when the vaccine wasn’t available, it was just tragedy after tragedy after tragedy,” Cobia told AL.com this week. “You know, so many people that did all the right things, and yet still came in, and were critically ill and died.”

In the United States, COVID is now a pandemic of the unvaccinated, according to the head of the U.S. Centers for Disease Control and Prevention. In Alabama, state officials report 94% of COVID hospital patients and 96% of Alabamians who have died of COVID since April were not fully vaccinated.

“A few days later when I call time of death,” continued Cobia on Facebook, “I hug their family members and I tell them the best way to honor their loved one is to go get vaccinated and encourage everyone they know to do the same.”

“They cry. And they tell me they didn’t know. They thought it was a hoax. They thought it was political. They thought because they had a certain blood type or a certain skin color they wouldn’t get as sick. They thought it was ‘just the flu’. But they were wrong. And they wish they could go back. But they can’t. So they thank me and they go get the vaccine. And I go back to my office, write their death note, and say a small prayer that this loss will save more lives.”

More than 11,400 Alabamians have died of COVID so far, but midway through 2021, caring for COVID patients is a different story than it was in the beginning. Cobia said it’s different mentally and emotionally to care for someone who could have prevented their disease but chose not to.

“You kind of go into it thinking, ‘Okay, I’m not going to feel bad for this person, because they make their own choice,’” Cobia said. “But then you actually see them, you see them face to face, and it really changes your whole perspective, because they’re still just a person that thinks that they made the best decision that they could with the information that they have, and all the misinformation that’s out there.

“And now all you really see is their fear and their regret. And even though I may walk into the room thinking, ‘Okay, this is your fault, you did this to yourself,’ when I leave the room, I just see a person that’s really suffering, and that is so regretful for the choice that they made.”

Cobia said that the strain wears on healthcare workers after the trauma of 2020 and 2021.

“It’s really hard because all of us physicians and other medical staff, we’ve been doing this for a long time and all of us are very, at this point, tired and emotionally drained and cynical,” she said.

Cobia said the current wave of Delta patients reminds her of the time in October and November of 2020, just before Alabama’s peak of coronavirus cases and deaths.

“What we saw in December 2020, and January 2021, that was the absolute peak, the height of the pandemic, where I was signing 10 death certificates a day,” she said. “Now, it’s certainly not like that, but it’s very reminiscent of probably October, November of 2020, where we know there’s a lot of big things coming up.”

Cobia worries that the upcoming school year will lead to a similar surge.

“All these kids are about to go back to school. No mask mandates are in place at all, 70% of Alabama is unvaccinated. Of course, no kids are vaccinated for the most part because they can’t be,” Cobia said. “So it feels like impending doom, basically.”

Cobia also had a personal experience with the virus, contracting it in July while 27 weeks pregnant with her second child. Her symptoms were mild and the child, Carter, was delivered early out of caution but suffered no serious complications.

Her husband, Miles, is also a physician, and the couple says they were both extremely cautious about wearing protective equipment but one of them still caught the virus and gave it to the other, as well as other family members.

“We still went to work but we masked 100% of the time,” Cobia said. “We didn’t go anywhere or do anything, we ordered through Shipt for all of our groceries, we did nothing at the time.”

Cobia said she delivered in September without incident and got the vaccine herself in December when it was made available to healthcare workers.

“I did not hesitate to get it,” she said. “There was a lot unknown at that time, because I was still breastfeeding about whether that was safe or not. I talked to as many other physician colleagues as I could and spoke with my OB as far as data that she had available and decided to continue breastfeeding after vaccination.”

Read More: Unvaccinated represent 96% of Alabama COVID deaths since April

For people who are hesitant to receive the vaccine, Cobia recommends speaking to their primary care physician about their concerns, just as she did.

“I try to be very non-judgmental when I’m getting a new COVID patient that’s unvaccinated, but I really just started asking them, ‘Why haven’t you gotten the vaccine?’ And I’ll just ask it point blank, in the least judgmental way possible,” she said. “And most of them, they’re very honest, they give me answers. ‘I talked to this person, I saw this thing on Facebook, I got this email, I saw this on the news,’ you know, these are all the reasons that I didn’t get vaccinated.

“And the one question that I always ask them is, did you make an appointment with your primary care doctor and ask them for their opinion on whether or not you should receive the vaccine? And so far, nobody has answered yes to that question.”